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January 20, 2020Cancer MedicineOpen Access

Causes of death among cancer patients in the era of cancer survivorship in Korea: Attention to the suicide and cardiovascular mortality

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Key result

Among 2,707,520 Korean cancer patients, 87.2% of deaths were due to the primary cancer, but noncancer deaths increased over time, including a 20-fold increase in cardiovascular deaths and a higher risk of suicide (SMR 1.68 in men) compared to the general population.

Why the study?

Improved cancer survival was expected to increase noncancer deaths, but detailed causes of death had rarely been discussed and required evaluation.

Population

2 707 520 cancer patients in the 2000-2016 national cancer registry in Korea

Comparison

Cancer patients vs general population

Design

National cancer registry-based cohort study

Authors

COChang‐Mo OhKyung Hee UniversityDLDahhay LeeNational Cancer CenterHKHyun‐Joo KongNational Cancer Center

Discussion

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Member takes

Overview

Increasing noncancer mortality including CV and suicide risks in cancer patients warrants vigilance; hypothesis-generating for survivorship care models and trials.

Study Design

Type

Cohort (n=2,707,520)

Structured PICO

P
Population
2,707,520 patients diagnosed with malignant primary tumors in South Korea between 2000 and 2016, followed until the end of 2016 to evaluate causes of death.
C
Comparator
General population
O
Outcome
Cancer and noncancer-related causes of deathhard clinical

Main Result

Effect estimate: SMR 1.68 (95% CI 1.63-1.74)

While primary cancer remains the leading cause of death in cancer survivors, noncancer deaths, particularly from cardiovascular disease and suicide, are significantly increasing and require targeted follow-up.

Limitations

  • Reported causes of death may have included errors or misclassifications.
  • Small number of noncancer-related deaths when estimating SMR according to specific cancer sites.
  • Direct comparison of cause of death proportions between US and South Korea is difficult due to differences in cancer types, stages, and healthcare systems.
  • Causal interpretations should be applied cautiously as cancer survivors may experience differing health conditions and behaviors compared to the general population.
  • Did not consider mortality risk variations with respect to the period of cancer diagnosis.

Cite This Study

Oh et al. (2020) conducted a cohort in Cancer (n=2,707,520). Cancer diagnosis vs. General population was evaluated on Cause of death (index cancer, nonindex cancer, noncancer) and standardized mortality ratios (SMRs) for noncancer deaths (SMR 1.68, 95% CI 1.63-1.74). Among 2,707,520 Korean cancer patients, 87.2% of deaths were due to the primary cancer, but noncancer deaths increased over time, including a 20-fold increase in cardiovascular deaths and a higher risk of suicide (SMR 1.68 in men) compared to the general population.

synapsesocial.com/papers/6a7718ffd3a6aa87c6bd91dbhttps://doi.org/10.1002/cam4.2813
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cancer and the Risk of Suicide in Older Americans2008 · 128 citations
  2. 2Suicide and Cardiovascular Death after a Cancer Diagnosis2012 · 461 citations
  3. 3Cancer and aging: Epidemiology and methodological challenges2016 · 71 citations
  4. 4Improved Estimates of Cancer-Specific Survival Rates From Population-Based Data2010 · 456 citations
  5. 5Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage2008 · 595 citations